The American College of Obstetricians and Gynecologists (“ACOG”) is hardly the most objective source of medical information. As we discussed on this blog two years ago, ACOG has gone out of its way to deny the link between birth malpractice and brain injury, as part of an effort to protect negligent doctors. This time, however, it seems they’re doing the right thing.
Earlier today, ACOG published new guidelines for “Prevention and Management of Obstetric Lacerations at Vaginal Delivery.” These guidelines are meant as an update to recommendations ACOG made back in 2006, when ACOG discouraged doctors from using “episiotomies.” Forty years ago, an episiotomy was performed in an incredible 60 percent of vaginal deliveries. By 2005, the rate was down to 33 percent. By 2012, it was down to 12 percent.
An “episiotomy” is a surgical cut of the perineum, the area between the vagina and the anus, which obstetricians have used in the past for two purposes. First, episiotomies are used when a baby is in danger (such as when they show signs of fetal distress, infection, or a lack of oxygen) as a means of getting the baby out sooner. Second, episiotomies are used to as a way of ‘controlling’ the way a mother’s vagina might tear during delivery. The thinking was that an episiotomy could limit the potential harm of a vaginal delivery, preventing mothers from suffering a third-degree or fourth-degree tear, or of suffering an irregular tear, like one that affected the perineal muscle or the anus.
The rate of episiotomies has gone down so much over the last forty years because studies have shown, over and over again, that it doesn’t work to prevent serious tears. There’s simply no “routine” reason to use an episiotomy. The new ACOG guideline reminds obstetricians, who like many doctors are very slow to grasp the changes in medical knowledge, that “routine” episiotomies still aren’t a good idea, and that women who previously suffered a severe tear or laceration in a vaginal delivery can choose to have a cesarean section.
As lawyers who regularly see the damage caused by obstetricians, midwives, and labor nurses who don’t follow the current evidence, we’re glad to see ACOG taking steps towards educating their members about these issues. Episiotomies and cesarean sections have their place in medicine, and doctors should know exactly when they are best given as options to the patients.